<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    {:token()}

    <div class="form-group">
        <label for="c-level" class="control-label col-xs-12 col-sm-2">{:__('充值次数')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-level" data-rule="required" class="form-control" name="row[nums]" type="number" value="" >
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('备注')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div>
                <textarea class="form-control" name="row[remark]" data-rule="required"></textarea>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('淘宝单号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-title" class="form-control" name="row[taobaoorder]" type="text" data-rule="required">
        </div>
    </div>
    <div class="form-group hidden layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed btn-callback">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
